# State Of The Art Research
## Decentralizing Medical Records using the Blockchain

### Built In | [background]
[How Using Blockchain in Healthcare Is Reviving the Industry’s Capabilities](https://builtin.com/blockchain/blockchain-healthcare-applications-companies)
submitter: Gabe Kotsonis

This article briefly discusses the use of blockchain in existing health platdorms, and provides examples of use cases. In particular, it mentions the fact that Estonia began using blockchain technology in 2012 to "secure healthcare data and process transactions," and now, ALL of the country's healthcare billing is done on a blockchain, as well as 95% of health information and 99% of prescription information. Following this, it overviews a number of different companies who are currently leveraging blockchain to help with healthcare security. These company descriptions are brief, but describe what each company does, how it uses blockchain, and its real-world impact since inception. I will likely look deeper into some of these companies for further research.

### Medium | [competitive]
[Medicalchain - the future of healthcare](https://medium.com/medicalchain/medicalchain-the-future-of-healthcare-5b130cbba439)
submitter: Gabe Kotsonis

This article is written by an employee of Medicalchain, and details the company, the implementation of its service, and its current uses. Starting off, the author writes that Medicalchain provides "the infrastructure upon which digital health applications and services are to be built," making it sound like Medicalchain's scope is a bit broader than our project's. Medicalchain has partnered with a company called Civic, which provides user authentication services through biometrics. Following this, the author notes that Medicalchain was built using a dual blockchain structure; one blockchain was built using Hyperledger Fabric and is used to control access to health records, while the other is "powered by an ERC20 token on Etherum and underlies all the applications and services on our platform." The hyperledger blockchain ensures necessary security and privacy, and the ethereum blockchain is used for computing and providing developers with a network ecosystem and applications they can contribute to using Medicalchain's "MedToken" (I'm still not totally sure what this means, will do more research). Another interesting point the author touches on is the use of Smart Contracts on the ethereum blockchain. These smart contracts can be used to automate and validate processes that normally require a notary or professional (such as billing and insurance-related activity that costs physicians 3.8 hours per week on average). The author also mentions that Medicalchain is a provider of telemedicine, allowing both patients and doctors more flexibility with consultations. Finally, another benefit of storing health data on the blockchain is that pharmaceutical and research companies will no longer need to approach hospitals or clinics for patient information, increasing efficiency and transparency.

### Upgrad | [method]
[How To Use Blockchain To Store Data](https://www.upgrad.com/blog/how-to-use-blockchain-to-store-data/)
submitter: Gabe Kotsonis

This article (as the title suggests) describes how to store data using the blockchain. The author briefly overviews what blockchain is (individual blocks of digital information that are held in a public database). He mentions that cloud storage is a traditional way of storing data, but the information is centralized and thus more vulnerable (also, data is usually not encrypted during transactions). Thus, there is a need for decentralized data storage. Blockchain can provide this functionality using either On-chain or Off-chain. WIth the on-chain method, all the data is stored inside each block in the chain, so if an attack happens, data can be restored and used. Restoring data using on-chain is VERY costly, so most storage options opt for off-chain storage, which just stores metadata (this is more cost-efficient, but data may not get restored in the event of a system breach). Following this, the author details different ways to implement data storage using blockchain, including interplanetary file systems, decentralized cloud storage, distributed databases, BigChainDB, hashing the data in the blockchain, TiesDB, etc.

### TechCrunch | [competitive]
[Proof Work aims to decentralize medical data by using the blockchain](https://techcrunch.com/2017/12/04/proof-work-aims-to-decentralize-medical-data-by-using-the-blockchain/)
submitter: Gabe Kotsonis

This article details a bit of why there is a need for decentralized health records, mainly highlighting the fact that data isn't easily shared between care providers. It then discusses Proof Work, a company out of Tel Aviv whose main goal is to "allow patients to walk into a doctor's office with all their medical records already on their phone." Furthermore, Proof Work hopes to give patients more control over their medical data and how it is shared (transactions are also transparent, so they would know who is using their data and why). The article does note that one potential challenge to this product is that healthcare companies aren't very interested in making health record access easier for their patients, so this is definitely something we should look into and flesh out a bit more (and see if there is a simple workaround).

### Advanced Data Systems Corporation | [market]
[Problems with Electronic Health Records](https://www.adsc.com/blog/problems-with-electronic-health-records)
submitter: Gabe Kotsonis

This article mainly discusses issues with the current ways medical data is stored, presenting us with a number of problem statements that we can work to address. The author details four main issues with electronic health record storage, including security concerns, data bottlenecks, and the fact that some users may not be familiar with the interface or process of storing records electronically. While the article is mainly directed at highlighting the issues with electronic vs. paper storage of data, it definitely addresses legitimate issues with electronic storage, so through our project, it would be useful to try to ameliorate some of these issues that supposedly plague many of the current electronic medical record storage systems.

### Github | [method/competitive]
[MedicalChain Smart Contracts](https://github.com/dadheech-vartika/Medical-Chain/tree/master/contracts)
submitter: Kevin Cai

Due to the open-source nature of public smart contract blockchains, MedicalChain - a direct competitor, have publicly visible contracts. These contracts are written in the programming language Solidity, which allows for smart contract functionality on different Ethereum Virtual Machine compatible blockchains. This source gives us a glimpse into how they use smart contracts to store and retrieve data from the blockchain. It also allows us to see what design features they have used to facilitate their business. In particular, the doctor.sol contract implements functionality to facilitate permissions for an address to map to a Doctor's name. This doctor can then be given special permissions on behalf of their patients. We can also see how the OpenZeppelin Ownable.sol contract has been used to ensure security by restricting who can call which functions to retrieve patient information in optimized_healthCare.sol. We can take inspiration from the functionality that MedicalChain have implemented to decide how we can differentiate our product from the rest of the market.

### Medium Article | [method]
[Ultimate Guide to Convert a Web App To a Decentralized App Dapp](https://medium.com/ethereum-developers/ultimate-guide-to-convert-a-web-app-to-a-decentralized-app-dapp-f6112a079509)
submitter: Kevin Cai

This Medium article describes the technical requirements for a Decentralized Application (DApp). It shows us the configuration for building a DApp, including installing web3.js - a javascript library used to interact with smart contracts on a blockchain. It also describes the use of the MetaMask chrome extension that is used a blockchain wallet to sign transactions to a live blockchain - or the Ropsten Test Network. The article demonstrates the conversion of a messaging app to a decentralized version of it. This includes description of the smart contracts required to store information from the app onto the blockchain, and interaction with the smart contracts using Web3.js.

### Sage journals | [method/market]
[Electronic health records in a Blockchain: A systematic review](https://journals.sagepub.com/doi/full/10.1177/1460458219866350)
submitter: Kevin Cai

The paper begins by proposing the use of blockchain technology to improve the security, privacy and interoperability of healthcare data. Having more widespread and secure access to this data is a positive movement in medical research since it eliminates the expenditure of research institutions when gathering data that already exists elsewhere. This is applicable and translatable to the concept of making medical records more accessible to hospitals around the US or around the globe. They describe that private blockchains can allow for "no interaction costs", whereas public blockchains require gas to be paid into smart contracts to write to the blockchain. This is a thought-provoking idea, that raises more questions on how it is best for us to implement our project - should it be on a public/private/hybrid blockchain? Are the costs associated with working on a private blockchain really zero?

### NCBI | [method/background]
[ Application of Blockchain to Maintaining Patient Records in Electronic Health Record for Enhanced Privacy, Scalability, and Availability](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7010942/)
submitter: Kevin Cai

The article discusses the use of Hyperledger Fabric - a consortium blockchain for storing medical records. This may have higher security and privacy since data is not written to a public database. This may also have lower costs since gas is not required to power smart contracts. Since the paper proposes the use of a consortium blockchain, the permissioned nodes on the network are hospitals using the technology. This provides a robust alignment of incentives where there is a high degree of trust between nodes to form consensus, rather than a public blockchain where there may be agents with bad incentives.

### Medium | [method]
[The ultimate end-to-end tutorial to create and deploy a fully decentralized Dapp in ethereum](https://medium.com/ethereum-developers/the-ultimate-end-to-end-tutorial-to-create-and-deploy-a-fully-descentralized-dapp-in-ethereum-18f0cf6d7e0e)
submitter: Kevin Cai

The article describes the software development process to deploy a DApp to the Ethereum blockchain. This includes the use of the Ropsten Test network to test on a live blockchain, hosting using IPFS to store data in a distributed manner, React.js as a front-end framework, Solidity to program smart contracts, Web3.js to interact with the smart contracts, node.js as a development server, Truffle to deploy, test and compile contracts and Metamask for a user to store private keys easily. The article shows the step by step process of developing smart contracts, deploying them, testing them and integrating them into a full-stack web application.

### MedCity News | [background]
[Blockchains are the building blocks of better healthcare](https://medcitynews.com/2021/03/blockchains-are-the-building-blocks-of-better-healthcare/)
submitter: Tanvir Islam
The article adresses how the current system in maintaining medical data is rather inefficient, so the solution to stream-line such a system would be blockchain. One of the biggest reasons is that it is totally feasible, infact a global blockchain could easily and efficiently store the neccisarry data, and be completely within scope.

### IBM | [background]
[What is blockchain technology?](https://www.ibm.com/topics/what-is-blockchain)
submitter: Tanvir Ilsam
This article gives useful background as to what Blockchain specifically is. It addresses the core principals that blockchain is an effiecent ledgering system that keeps track of information and who has access to that information. It is effiecent and can cut costs for many businesses as it provides immediate access to transparent information stored on an unchangeable ledger to parties who have permission to access said information, which makes it a perfect system for medical records; as only the primary caretaker and anyone attending to the patient should have access to their data.

### MedicalChain | [competition]
[Medical Chain](https://medicalchain.com/en/)
submitter: Tanvir Islam

This is a company who has already implemented blockchain technologies in keeping track of patient information. Something that is fairly interesting is the fact that they have a system in which the patient grants access to who is able to view their health records and create a time frame for how long one can view their records which would guarentee data security.

### SupplyChainDigital | [method]
[How Vechain technology is changing the supply chain industry](https://supplychaindigital.com/technology/how-vechain-technology-changing-supply-chain-industry)
submitter: Tanvir Islam

Vechain is a company/organization that is currently using blockchain technologies for supply chain management for many companies and governments. The use of an immutable ledger allows organizations to accurately state how much of one thing is going where, and since it is immutable it cannot be changed, this combats the skimming of products.

### CoinDesk | [method/competition]
[Louis Vuitton Owner LVMH Is Launching a Blockchain to Track Luxury Goods](https://www.coindesk.com/markets/2019/03/26/louis-vuitton-owner-lvmh-is-launching-a-blockchain-to-track-luxury-goods/)
submitter: Tanvir Islam

The owner of Louis Vuitton is launching a blockchain platform to keep track of its goods, and ensure their authenticity. This is a very innovative move to curb counterfiet culture, as this immuttable ledger will ensure that no products can be skimmed from any shipments, and ensure the proper ammount of products arrive to the proper locations. This method may also introduce an ownership system, where the owner of each LV product may be documented, to not only control the market but ensure the owners of louis vuitton products have real products.